....some CyberKnife radiation must pass through the rectum to get to the prostate, and it is at a high enough dose that it caused problems for a substantial percentage of men in one of Dr. King's papers. That's why the same dose rate for HDR brachy may have a much more benign impact on the rectum than if delivered by CyberKnife (or any other external system).
...

I just wanted to add a comment to this particular part of Jim's excellent followup info and questions post-- there is a great amount of care given to the maximum dose of proton radiation, and I presume the other forms as well, since too much can lead to problems you mentioned with the rectum.

At Jacksonville, some men received two or three more treatments (of 2 Gy) than others did. I was on the low end, at 39 doses of 2 Gy. for 78 Gy in total during my treatment period. Towards the end, there was some consideration as to my having an additional dose, but the conclusion was "no" given my particular makeup and their concern to give just enough and not too much. So I would want to know a little more about potential for complications down the road with Cyberknife given the very high doses used/day.

There is a lot of data about to be released at the CyberKnife users meeting the first week of Feb. 2009.

The data from the clinical trail I am in has passed 5 years for the first patient and he has no side effects.

There are critics/skeptics of SBRT/CyberKnife expressing unknown side effects for the higher dose per fraction. They seem to ignore the 10 years of HDR Brachytherapy monotherapy and 20 years of HDR Brachytherapy as a boost to 2D RT or 3D RT or IMRT.

The side effects are no worse than any other option. I am amazed that the data is so good considering the first patients for any treatment usually do not do as well because as the 100th due to the learning curve with any treatment. The Christopher King study reports ZERO failures and low side effects. There is no logical theory that supports low side effects at on two and three years then increases. If there is a problem it typically starts to be apparent in the first year and may increase.

...
There is a lot of data about to be released at the CyberKnife users meeting the first week of Feb. 2009.

The data from the clinical trail I am in has passed 5 years for the first patient and he has no side effects.
....

It should be interesting to learn what is provided at the meeting next month- hope you can provide an update when you learn what's presented. Do you know any more about that first patient you mentioned-- such as age, initial Gleason score, PSA etc, and what the PSA figures have been each year since treatment?

The first patient is a neurosurgeon with localized PCa. He lives in the NW and contacted Stanford when he was diagnosed with CaP as he had heard about the CyberKnife being approved by the FDA for tumors outside of the cranium and asked if he could be treated with the CyberKnife. The Clinical stared with him. I have no knowledge of his Gleason score or PSA at treatment. He has no side effects and based on PSA monitoring is still disease free. We did not go into the details at dinner.

Not sure of his age today but est 68-70.

The PSA drop per year after radiation is not the most important criteria, a decreasing or stable PSA is the goal. Each patient treated with Radiation, of all types, will have a different PSA response for the first 2-3 years until NIDAR is reached.

The library trip was a success, thanks to some super help from the librarian. I was able to get the King paper, plus one by Fuller, another one that was footnoted in the King paper, and the librarian is going to dig into the archives in the basement and email me a scanned image of a 1990 paper about a 22 years of "hypofractionated" radiation in the UK - meaning a lot of radiation in just a few sessions. That may help smoke out some of the issues if its on point, especially the concern about late onset rectal toxicity. Granted, it's not CyberKnife delivery, but if there is not much for very old delivery systems, that would be a good indicator for CyberKnife. (If there was a problem, well, the evidence would not help us much: CyberKnife might avoid that problem due to much greater accuracy and modern techniques, such as using medications to help protect the rectum during treatment.

It's interesting that hard copies of the King paper have not been printed yet, though an electronic version of that paper has been available for some time. That's what the librarian was able to access, with a little trouble, and print for me. (Inova Fairfax Inova Hospital does this for free for patients. Pretty nice!)

(I also got a couple of papers with Dr. Mark Scholz as a co-author on hormonal blockade, my main interest.)

Jim

Last edited by IADT3since2000; 01-10-2009 at 07:26 AM.
Reason: Mental typo: reversed Fairfax and Inova. Weird, as I know that institution very well!

That is great! Enjoy the reading and enjoy the radiation oncology journey. ...

Fred,

I've already read the King paper twice, but I'm still studying it. I'm seeing a lot of confidence building results and enthusiasm as I look at the SBRT CK approach, and my hunch is that the leading docs are going to be able to work out the wrinkles.

FYI there are 100 CyberKnife's in the US. The number of medical centers treating Prostate cancer is approx. 40. Not sure of the exact number but if you want to know I can find out the present number of centers treating prostate cancer. There are two studies that have several hundred patients each waiting for Peer Review.
This is far from an investigational treatment however ther are many who want to hold back progress.

From the research done to overturn the denial from my Insurer I communicated with several outstanding CyberKnife doctors who shared their data. At the CyberKnife users meeting papers will be presented in a few weeks from around the World.

The C.King Data is being repeated at many center by many excellent doctors. What makes the CyberKnife doctors so exceptional is the depth of knowledge and experience with radiation therapy. And their ability to accept change and embrace it. The all use IMRT or 3D RT and CyberKnife and many also provide Brachytherapy. With the all these tools for treating cancer they offer the patient the choice of all their tools suitable for their specific cancer. If a treatment facility has X Radiation Tool, that was been shown to treat PCa, they will tell their patients that they can treat their cancer. They will not tell the patient there is another one or more options offered at other Treatment Facilities they may want to consider.

Suggest you look at HDR Brachytherapy and Hypofractionation to understand the the benefit of increased dose per fraction/session and fewer sessions vs lower dose per session for 8-9 weeks.

Then look at the realtime target tracking of the CyberKnife which is not possible with any other option today. The robot can move to 1200 angles which makes a dose plan that covers the target but quickly declines near critical structures. Result hi dose to the target low dose to critical tissue = high cure and low toxicity.

In a different post you referenced 9 hits you found on PubMed by searching "prostate cancer AND Cyberknife". I did not get those hits when I did the same search. Any suggestions?

Thanks

I'm assuming you got more than the nine hits I got the other day.

I just tried the same search again and got 12 hits. Even though the latest three were not all from 2009, I suspect they were added very recently. The list will continue to grow as more papers are published.

Publication of medical studies is a real problem in medicine. By the time articles are published it is a year later. This means we are always behind the real standard of care by at least a year. I find this unacceptable.

The CyberKnife has treated now treated a couple thousand patients with very good published results.

I have the abstracts from the CyberKnife users meeting that ended 2-7-09 and would be happy to copy them to a pdf file and email them to anyone who wants them.

If you search CyberKnife, Dr. Christopher King, and Dr. Donald Fuller you should get good hits. Dr. King's study is the longest and his results are very good. No failures to date, low rate of side effects. This I find outstanding as all treatments have a learning curve. One would expect patient 20 to do better than patient 1.

The CyberKnife is very quickly becoming the standard of care across the US. Because of the lag time of publication and some other political/economic issues some insures do not cover the CyberKnife. Think about the cost of IMRT(40 treatment days doctor required at every treatment) to the health care system and the cost of the CyberKnife (5 days of treatment) IMRT which is more expensive to the patient and the insurer, was on a big growth curve driven by prostate cancer. That is now slowing and those newly invested in IMRT are saying there is not enough data or time. But a couple years ago when IMRT being pushed by Doctors without long term data. Like it or not this is a big business for doctors, institutions and free standing treatment centers.

The patient must be well informed before making a choice. The choice is the patients to make not the doctor or health care system.

The improvement in prostate cancer treatments have been good compared to 10 years ago. As imaging continues to improve so will localized treatments. If prostate had the same funding as breast cancer we would have better treatments today.

Publication of medical studies is a real problem in medicine. By the time articles are published it is a year later. This means we are always behind the real standard of care by at least a year. I find this unacceptable.

The CyberKnife has treated now treated a couple thousand patients with very good published results.

I have the abstracts from the CyberKnife users meeting that ended 2-7-09 and would be happy to copy them to a pdf file and email them to anyone who wants them.

If you search CyberKnife, Dr. Christopher King, and Dr. Donald Fuller you should get good hits. Dr. King's study is the longest and his results are very good. No failures to date, low rate of side effects. This I find outstanding as all treatments have a learning curve. One would expect patient 20 to do better than patient 1.

The CyberKnife is very quickly becoming the standard of care across the US. Because of the lag time of publication and some other political/economic issues some insures do not cover the CyberKnife. Think about the cost of IMRT(40 treatment days doctor required at every treatment) to the health care system and the cost of the CyberKnife (5 days of treatment) IMRT which is more expensive to the patient and the insurer, was on a big growth curve driven by prostate cancer. That is now slowing and those newly invested in IMRT are saying there is not enough data or time. But a couple years ago when IMRT being pushed by Doctors without long term data. Like it or not this is a big business for doctors, institutions and free standing treatment centers.

The patient must be well informed before making a choice. The choice is the patients to make not the doctor or health care system.

The improvement in prostate cancer treatments have been good compared to 10 years ago. As imaging continues to improve so will localized treatments. If prostate had the same funding as breast cancer we would have better treatments today.

I would appreciate getting the abstracts from the February CyberKnife meeting. Thanks.